Predicting Caries Risk in Underserved Children, from Toddlers to the School-Age Years, in Primary Healthcare Settings

预测初级医疗机构中服务不足的儿童（从幼儿到学龄儿童）的龋齿风险

• 批准号: 10213006
• 负责人: Margherita R Fontana
• 金额: $ 154.87万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-23 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10213006
• 关键词: 5 year old; 7 year old; 8 year old; Academy; Affect; Age; Age-Years; American; Area; Assessment tool; Biological; Child; Childhood; Chronic Disease; Cohort Studies; Data; Data Analyses; Dental; Dental Care; Dental caries; Dentists; Development; Disease; Dyes; Early treatment; Enrollment; Environment; Expenditure; Experimental Designs; Follow-Up Studies; Goals; Grant; Health; Health Care Costs; Health Personnel; Health Services Accessibility; Healthcare; Incidence; Interdisciplinary Study; Intervention; Lesion; Life Cycle Stages; Medicaid; Medical; Methods; Minority Groups; Mixed Dentition; Modeling; Monitor; National Institute of Dental and Craniofacial Research; Oral; Oral health; Patients; Pattern; Pediatrics; Physicians; Policies; Population Group; Population Heterogeneity; Predictive Value; Prevalence; Prevention; Preventive; Preventive therapy; Preventive treatment; Primary Dentition; Primary Health Care; Process; Provider; Publishing; Questionnaires; Research; Research Personnel; Resources; Risk; Risk Assessment; Risk Factors; School-Age Population; Schools; Specialist; Strategic Planning; Subgroup; Therapeutic; Toddler; Tooth structure; Triage; Visit; Work; aged; base; care providers; clinical risk; cohort; cost; cost effective; craniofacial; deciduous tooth; design; disorder prevention; disparity reduction; early childhood; ethnic minority population; evidence base; experience; health assessment; health care delivery; health care settings; health disparity; implementation tool; innovation; low socioeconomic status; multidisciplinary; neglect; permanent tooth; predictive modeling; prevent; primary caregiver; primary outcome; programs; racial and ethnic; racial minority; sex; tool; tooth surface

Project Summary/Abstract: Dental caries, one of the most common chronic diseases of childhood, is a largely preventable disease, yet approximately 23% of U.S. children 2-5 years-of-age experience dental caries, and this number more than doubles to 56% among those aged 6-8. In the current environment of escalating healthcare costs and resource constraints, the large disparities in caries experience and access to care that exist in the U.S., especially among low socioeconomic status (SES) and minority population groups, call for a greater focus on targeted (at the patient and tooth surface level), risk-based caries preventive and therapeutic strategies to be delivered through interprofessional partnerships, including primary healthcare settings. Our team has just finished following 1,326 children from age 1 to age 4, and we have started data analyses to validate a caries risk questionnaire for use by medical providers to accurately identify high caries risk toddlers. The problem is that, while caries experience more than doubles from ages 2-5 to 6-8, caries in primary teeth during mixed dentition is a largely neglected area of research and prevention, there is no validated caries risk tool for medical settings to easily help triage 5- 8 year old children, and there have been almost no studies following the life-course progression of caries in children 1-8. This information is critically important, as designing and targeting efficacious and cost-effective preventive therapies that can adapt to changes in the life-course from toddlers to school-age children is dependent on accurate risk factor and tooth surface assessment. Thus, the objectives of this innovative continuation renewal study are: 1) to develop a practical and easily-scored caries risk tool for use in primary medical healthcare settings to identify high caries risk children, expanding from the toddler (1-4) to the school-age years (5-8); and 2) to determine the relationships between caries risk profiles and caries disease patterns (e.g., occlusal vs. proximal) in the mixed dentition. This will be accomplished by following a cohort of 876 primary caregiver (PCG)-child pairs from our ongoing U01's enrolled pairs. This cohort represents a diverse population, including ethnic/racial minorities and low SES groups. The PCG will complete a caries risk questionnaire and the child will have caries examinations at baseline (child's age 5.5 years old + 3 months), and again at 18 months (child's age 7 years + 3 months) and 36 months after baseline (child's age 8.5 years + 3 months) to monitor the caries disease process. Longitudinal caries risk data and caries disease prevalence/incidence and tooth surface pattern information collected from age 1-4 (ongoing U01) and 5-8 (proposed continuing renewal) will be used to assess risk of caries in children ages 5-8. A great strength of this proposal is that it involves four experienced medical and dental investigator groups, who have successfully worked together for the past 5.5 years and can facilitate follow-up of the study cohort. The significance is that identification of high caries risk children in primary healthcare settings will allow cost- effective preventive and/or referral strategies to be developed, targeted and used in interprofessional settings to prevent caries development from the toddler to the school-age years. This will have immediate broad impact and influence on existing and/or new policies and programs to be delivered by non-dental professionals in medical settings and other non- healthcare settings (e.g., school-based), as well as by dental professionals in dental healthcare settings.

项目概要/摘要： 龋齿是儿童最常见的慢性疾病之一，是一种在很大程度上可以预防的疾病， 23%的美国2-5岁儿童患有龋齿，这一数字翻了一番多，达到56%。 6-8岁。在当前医疗保健成本不断上升和资源限制的环境下， 美国现有的医疗经验和途径，特别是低社会经济地位（SES）和少数民族 人口群体，呼吁更多地关注有针对性的（在患者和牙齿表面水平），基于风险的龋齿预防 和治疗策略，通过跨专业的伙伴关系，包括初级卫生保健机构提供。 我们的团队刚刚完成了对1,326名1岁至4岁儿童的跟踪调查，我们已经开始进行数据分析， 龋齿风险问卷，供医疗提供者使用，以准确识别高龋齿风险幼儿。问题是， 虽然从2-5岁到6-8岁龋齿的发生率增加了一倍多，但混合牙列期乳牙的龋齿在很大程度上是 被忽视的研究和预防领域，没有经过验证的龋齿风险工具用于医疗环境，以轻松帮助分类5- 8岁的儿童，几乎没有关于1-8岁儿童龋齿的生命过程进展的研究。 这一信息至关重要，因为设计和靶向有效和具有成本效益的预防性治疗， 能否适应从蹒跚学步到学龄儿童的生命历程变化，取决于准确的危险因素和牙齿 表面评估。因此，这项创新的延续更新研究的目标是：1）制定一个切实可行的， 用于初级医疗保健机构的易于评分的龋齿风险工具，用于识别高龋齿风险儿童， 从幼儿（1-4）到学龄期（5-8）;和2）确定龋齿风险概况和 龋齿疾病模式（例如，咬合对近端）。这将通过以下方式实现： 来自我们正在进行的U 01登记对的876个主要照顾者（PCG）-儿童对的队列。该队列代表了 多样化的人口，包括少数民族/种族和社会经济地位低的群体。PCG将完成龋齿风险 问卷，儿童将在基线（儿童年龄5.5岁+3个月）进行龋齿检查，并在基线（儿童年龄5.5岁+3个月）再次进行龋齿检查。 基线后18个月（儿童年龄7岁+3个月）和36个月（儿童年龄8.5岁+3个月），以监测 龋病过程。纵向龋齿风险数据和龋齿患病率/发病率和牙齿表面图案 从1-4岁（正在进行的U 01）和5-8岁（建议继续更新）收集的信息将用于评估 5-8岁儿童的龋齿。这项建议的一大优点是，它涉及四个经验丰富的医疗和牙科 在过去5.5年中成功合作并可促进研究随访的研究者小组 队列。重要的是，在初级卫生保健环境中识别高龋齿风险儿童将允许成本- 制定有效的预防和/或转诊战略，有针对性地在跨专业环境中使用， 从幼儿到学龄期的龋齿发展。这将立即产生广泛的影响和影响， 现有的和/或新的政策和计划将由非牙科专业人员在医疗环境和其他非 医疗保健环境（例如，以学校为基础），以及牙科保健机构的牙科专业人员。